A nurse is assisting with the care of a client 2 hr postoperative following a cardiac catheterization. Which of the following actions should the nurse take?
Check the client's distal pulses in both legs.
Keep the client overnight.
Keep the client on bed rest for 12 hr.
Restrict the client's oral fluids.
The Correct Answer is A
A. Check the client's distal pulses in both legs:
Checking the client's distal pulses in both legs is crucial to ensure that there is adequate blood flow and no signs of arterial occlusion or complications from the catheterization. This is an important assessment to detect potential vascular complications, such as a hematoma or an arterial blockage.
B. Keep the client overnight:
Keeping the client overnight is not typically required for all cardiac catheterization procedures. The need for an overnight stay depends on the individual case and any complications or comorbidities. Routine catheterizations often allow for discharge on the same day with appropriate monitoring.
C. Keep the client on bed rest for 12 hr:
Keeping the client on bed rest for 12 hours is excessive. Typically, bed rest is required for 2 to 6 hours following the procedure to allow the puncture site to stabilize and reduce the risk of bleeding. The exact duration of bed rest depends on the approach used and the patient's condition.
D. Restrict the client's oral fluids:
Restricting the client's oral fluids is generally not appropriate. In fact, increasing fluid intake is often encouraged to help flush out the contrast dye used during the procedure and to prevent renal complications. Monitoring for fluid balance is important, but outright restriction is not typically indicated unless there is a specific medical reason.
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Related Questions
Correct Answer is D
Explanation
A. Qualitative studies are considered to be one type of Level I evidence: Qualitative studies are not typically considered Level I evidence. The hierarchy of evidence is a rating system used to evaluate the strength of evidence presented in medical research. Level I evidence usually includes systematic reviews, meta-analyses, and randomized controlled trials.
B. Level Vil evidence comes from a meta-analysis of multiple peer-reviewed studies: This statement is not accurate. Meta-analyses and systematic reviews are usually considered Level I evidence, as they provide the highest level of evidence. They synthesize and analyze multiple studies on a topic to provide a comprehensive view of the current evidence.
C. Level I evidence includes evidence found in nursing textbooks: Nursing textbooks are not considered Level I evidence. They often include a mix of different levels of evidence, from expert opinion to systematic reviews. While they are a valuable resource for background information and clinical guidelines, they do not represent the highest level of evidence.
D. Level I evidence is considered to be the best evidence to support EBP: This is correct. Level I evidence, which includes systematic reviews, meta-analyses, and randomized controlled trials, is considered the highest level of evidence and provides the most reliable basis for decision-making in evidence-based practice
Correct Answer is C
Explanation
Acute respiratory acidosis occurs when there is inadequate excretion of carbon dioxide due to respiratory dysfunction, leading to an increase in carbon dioxide levels (hypercapnia) and subsequent acidosis (decrease in pH).
Manifestations of acute respiratory acidosis include:
A. Circumoral numbness and tingling - This is associated with respiratory alkalosis, not acidosis. B. Muscle flaccidity - This is more commonly seen in hyperkalemia or conditions affecting neuromuscular transmission. C. Decreased level of consciousness - This is a key manifestation of acute respiratory acidosis due to the effects of hypercapnia on the central nervous system. D. Cool, clammy skin - This is not typically associated with acute respiratory acidosis; instead, it might be seen in shock or hypoperfusion states.
Therefore, the nurse should expect to find a decreased level of consciousness in a client experiencing acute respiratory acidosis.
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